When selecting a health insurance policy, most people pay attention to the premium amount, sum insured, and inclusions such as pre- and post-hospitalization cover. But one aspect that significantly affects your experience with the claim is the type of hospital, i.e., whether it was a network or an Non-Network you visited.
Knowing the difference between network and non-network hospitals can save you time in case of an emergency. It will help you make quick decisions, facilitate a smooth claims settlement process, obtain a cashless facility overseas covered under your health insurance policy (if the policy explicitly covers international treatment), or pay upfront with reimbursement / cashless for a hospital not in the network.
In this detailed guide, let’s find out what is a network and non-network hospital, how they differ, the benefits of network hospitals, the disadvantages of non-network hospitals, and how to choose the right one under your health insurance policy.
What Are Network and Non-Network Hospitals?
Network Hospitals
Network hospitals are healthcare facilities that have a tie-up or agreement with your insurance company (or its Third-Party Administrator, TPA). These hospitals are part of the insurer’s approved list, often referred to as the list of network hospitals, where you can avail of cashless treatment.
The TPA plays a crucial role in facilitating this process. When you’re admitted to a network hospital, the hospital’s insurance desk coordinates with the TPA to obtain pre-authorisation for your treatment. The TPA verifies your policy details, coverage limits, and eligibility for cashless benefits. Once approved, the hospital proceeds with your treatment without requiring you to pay up front. After discharge, the TPA or insurer directly settles the hospital bills—except for non-payable items such as registration fees or consumables—ensuring a seamless cashless experience.
In simple terms, when you get admitted to a network hospital, you don’t need to pay the hospital bills out of pocket (except for non-payable items). The insurer directly settles the claim with the hospital, provided it’s covered under your policy.
Example: If you have a policy from XYZ Insurance and undergo surgery at an XYZ-listed network hospital, the insurer will pay the hospital directly, saving you from arranging funds during treatment.
Non-Network Hospitals
This category of hospitals does not have any formal agreement with your insurer. Traditionally, if you get treated at any such hospital, you’ll need to pay all expenses upfront and later file a reimbursement / cashless claim with your insurance company. However, with the introduction of the Cashless Everywhere facility, you can now also avail of cashless treatment at select non-network hospitals.
Under this facility, you can receive treatment at a non-network hospital without paying upfront—provided your insurer supports the Cashless Everywhere service and the hospital meets the necessary verification criteria. You simply need to inform your insurer or TPA in advance (for planned admissions) or within 24 hours (for emergencies), and the insurer will coordinate directly with the hospital for claim settlement.
Example: If you’re admitted to a non-network hospital during an emergency, you can either:
- Use the Cashless Everywhere facility (if available under your insurer) for direct settlement, or
- Pay first and later claim reimbursement / cashless/cashless by submitting all bills and discharge summaries for verification.
Both options are covered under most health plans, but the claim process, convenience, and speed of settlement vary significantly.
Key Differences Between Network and Non-Network Hospitals
Let’s compare them across key parameters to understand how each option impacts your healthcare experience.
Cashless Treatment Facility
The most significant difference between network and non-network hospitals is the availability of cashless treatment.
- Network Hospitals: Offer cashless claim settlement. You show your health card or policy details, and after pre-authorisation, your bills are directly settled by the insurer.
- Not in Network Hospitals: No cashless facility. You must pay bills upfront and claim reimbursement / cashless later by submitting original documents.
Claim Process & Settlement
- Network Hospitals:The claim settlement in network hospitals is smoother and faster. The insurer and hospital coordinate directly, ensuring minimal paperwork for the insured.
- Out-of-Network Hospitals: The claim process in a non-network hospital requires you to submit discharge summaries, bills, prescriptions, diagnostic reports, and claim forms. The insurer then verifies details before reimbursing you.
Upfront Payment vs Reimbursement / cashless
- Network No need to pay hospital charges (except for items not covered, like registration or consumables).
- Non-Network: You must pay the entire bill upfront, which can be stressful for high-cost treatments. Reimbursement / cashless follows only after document verification.
Tariffs / Negotiated Rates
Network hospitals have pre-negotiated tariffs with insurers, which means:
- The costs of surgeries, room rent, and tests are standardised and often discounted.
- You are protected from unregulated or excessive billing due to pre-negotiated tariffs.
In contrast, hospitals that do not have any formal agreement with the insurer charge their own rates, which might be higher. The insurer reimburses only up to what’s “reasonable and customary,” meaning you may need to bear the difference.
Waiting Time & Speed of Processing
- Network Hospitals: Have a dedicated insurance desk that handles claim approvals and documentation, resulting in faster admission and discharge.
- Not in Network Hospitals: The reimbursement / cashless claim process can take several days to weeks since the insurer must validate all records before payment.
Quality, Accreditation & Network Criteria
Insurance companies select network hospitals based on strict quality standards, infrastructure, accreditation, and service record. These hospitals are often accredited by the NABH (National Accreditation Board for Hospitals), ensuring that they provide high-quality care.
However, non-network medical facilities might include smaller or rural facilities that may not meet those standards but could still provide decent care.
In short, network hospitals are generally vetted for quality, while non-network ones vary in their standards.
Flexibility & Choice of Hospital / Specialist
- Network Hospitals: Limited to your insurer’s list. While most insurers have extensive networks, your preferred doctor may not always be available to practice at one of these hospitals.
- Non-Network Hospitals: Offer complete freedom—you can choose any doctor or hospital, regardless of network status.
Pros & Cons: Network vs Non-Network Hospitals
Let’s weigh the advantages and disadvantages of non-network hospitals and network hospitals to help you make a better decision.
| Aspect | Network Hospitals | Non-Network Hospitals |
|---|---|---|
| Key Advantage | Cashless admission and treatment | Freedom to choose any doctor or hospital |
| Claim Process | Faster claim approval and discharge through direct settlement | Requires you to pay upfront; reimbursement / cashless is processed later |
| Charges | Standardised and reasonably negotiated rates | May involve higher costs without negotiated pricing |
| Documentation | Easy pre-authorisation and minimal paperwork | Manual documentation and longer settlement timelines |
| Availability | Limited to the insurer’s approved hospital list | Some insurers have expanded their network to include rural hospitals, but coverage may still be limited compared to urban areas. |
| Treatment Options | Generally better facilities, but restricted to empanelled hospitals | Suitable for emergencies when network hospitals aren’t nearby |
| Potential Drawback | May not include your preferred doctor or specialised treatment centre | Risk of partial settlements or deductions during reimbursement / cashless — due to non-payable expenses (like consumables or administrative charges), missing documents, or treatment costs exceeding the insurer’s “reasonable and customary” limits. |
How to Choose Between Network and Non-Network Hospitals
Selecting where to seek treatment depends on urgency, policy terms, and convenience. Here’s how to make an informed choice.
Check Hospital Network Coverage
Before buying a health insurance plan, review the insurer’s list of network hospitals.
- Visit the insurer’s website or mobile app.
- Filter by your city or pin code.
- Check whether your preferred hospitals or specialists are part of the network.
A policy with a vast network ensures you can access cashless benefits anywhere in India.
Understand the Claim Terms & Limits
Different insurers have different processes for claim settlement in network vs non-network hospitals. For example:
- Cashless pre-authorisation is mandatory before availing of the facility.
- For reimbursement / cashless claims, you must submit original bills within 15-30 days post-discharge.
Also, be aware of any waiting period in health insurance for specific illnesses, as treatment before the waiting period may not be claimable even at a network hospital.
Compare Hospital Quality & Reputation
Network hospitals are pre-screened, but quality still varies. Consider:
- Accreditation (NABH/NABL-certified)
- Specialist availability
- Post-treatment support
If you have a preferred specialist who practices in a non-network facility, you may still opt for reimbursement / cashless-based treatment to receive better care.
Distance, Access & Travel Considerations
During emergencies, proximity is crucial. The nearest hospital may not always be in your insurer’s network. Hence, keep a mix of nearby network and non-network healthcare centres in mind. For planned procedures, utilise network hospitals to take advantage of cashless facilities.
In urgent cases, prioritise your health and choose the nearest available hospital—your health insurance will still cover the costs through reimbursement / cashless later.
Tips to Maximise Benefits from Network Hospitals
- Always carry your health card.
- Pre-authorise cashless claims for planned admissions 48–72 hours in advance.
- For emergencies, notify the insurer within 24 hours.
- Keep your ID proof and policy details handy.
- Review health insurance claim settlement ratio before choosing an insurer—higher ratios mean smoother claim experiences.
Conclusion
Understanding the difference between network and non-network hospitals is essential for a stress-free healthcare experience. Network hospitals offer convenience, speed, and financial ease through cashless claims and pre-approved tariffs. Meanwhile, out-of-network hospitals provide flexibility but require upfront payment and longer claim settlements.
For planned treatments, always opt for network hospitals to save time and avoid financial strain. During emergencies, don’t hesitate to visit the nearest hospital—your health insurance will still support you via reimbursement / cashless.
Ultimately, the best health insurance policy is one with a vast hospital network, transparent claim process, and high settlement ratio—ensuring you receive quality care when it matters most.
FAQ
You can still get treated. Pay the bills upfront, keep all original documents, and file a reimbursement / cashless claim later. The insurer will settle the eligible amount after verification is complete.
You don’t lose coverage, but you lose the cashless facility and may face delays or deductions in reimbursement / cashless.
Check the insurer’s website, mobile app, or call customer care for the list of network hospitals in your city. You can also search by hospital name or pin code.
Yes. Network hospitals have pre negotiated tariffs, often making treatments more affordable. Out-of-network hospitals charge standard rates, which can result in higher bills and partial reimbursement / cashlesss.
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